St. Bartholomew’s Hospital was founded in 1123! These days it is part of Barts Health NHS Trust and is mostly renowned for being Europe’s largest cardiac centre. In addition to the Heart Centre, there is a Cancer centre and of course a Thorax Centre! There is no Emergency Department, and as a consequence no Acute Medical Unit or general medical inpatients.

Job Structure

The Barts job is the only focussed subspecialty position on the North East London rotation and is for six months duration (rather than the usual 12). Trainees choose two out of three subspecialties, and do two three-month placements during their time at Barts.

The available subspecialties and corresponding consultants are:

Cystic fibrosis – Dr Danie Watson & Dr Nadia Shafi

Sleep and ventilation – Dr Nanak Singh and Dr Prina Ruparelia

Asthma and allergy – Dr Paul Pfeffer

The lung cancer service also has a footprint at Barts, but this is mostly run by the consultants and the interventional fellow and trainees are not directly involved.

Timetable

A draft timetable for each of the jobs is below.

CF/bronchiectasis

	am	pm
Monday	X-ray teaching 8am CF MDT Resp teaching 12.30pm	Consultant WR
Tuesday	SpR WR	CF / immunology clinic
Wednesday	Consultant WR	Bronchiectasis clinic
Thursday	CF/NTM clinic	Ward / admin
Friday	8.30am diagnostic MDT Consultant WR	Ward / admin

Sleep/vent

	am	pm
Monday	X-ray teaching 8am Consultant WR Resp teaching 12.30pm	Sleep/vent clinic
Tuesday	SpR Ward Round	Bronch/EBUS
Wednesday	Consultant WR	Sleep/vent clinic
Thursday	SpR Ward Round	General resp clinic alt weeks
Friday	8.30am diagnostic MDT Consultant WR	Sleep reporting

Asthma/allergy

	am	pm
Monday	X-ray teaching 8am Difficult asthma clinic Resp teaching 12.30pm	Severe asthma MDT
Tuesday	Allergy MDT	Allergy clinic
Wednesday	Admin	Bronch/EBUS
Thursday	Challenge testing	Allergy clinic
Friday	8.30am diagnostic MDT Difficult asthma clinic	Admin

On Call

Uniquely amongst the North East London rotations, as there is no GIM there are no resident evenings/nights! The day job is 9am – 5pm Monday – Friday. You will be on the non-resident on call rota (NROC) covering Barts and the Royal London. These shifts are 5pm – 9am the following day, and you are expected mostly to provide telephone advice. You also need to be able to come into the hospital if this required, although this has only happened extremely infrequently in the past.

There is also a weekend rota 1:5, where you see all patients on the respiratory ward with an SHO. These shifts are also 9am – 5pm.

Referrals

The respiratory department receives a substantial number of referrals from other teams on the Barts site – particularly cardiology/cardiac surgery and oncology. Referrals are mostly submitted electronically and divided between the different teams. There is also a respiratory bleep which is also shared between the teams. A lot of the referrals are for pleural procedures, and there is consequently good exposure to pleural aspiration and drains.

Pleural procedures

As above, there is good exposure to pleural procedures. There is a departmental ultrasound machine kept in the respiratory offices. It may be difficult to get level 1 ultrasound trained if you are not already.

Estimated numbers: 20 pleural aspirations and 5-10 drains in 6 months

Bronchoscopy

Sleep/vent and asthma/allergy jobs have a weekly bronch/EBUS list timetabled, although it is mostly EBUS.

Estimated numbers: 5 bronchs and 20 EBUS in 6 months

Teaching

There is an education fellow who organises weekly teaching on Monday lunchtime. There is X-ray teaching on Monday mornings by Dr Ellis via Teams.

Other specialist training opportunities

Take the chance to negotiate a day off to go and see some thoracic surgery while you are here!

Stage of training best suited to this rotation

ST5+